Critical care MCQs final cover.qxd 10/12/2014 17:38 Page companion for anyone sitting exams in intensive care, as a training resource or just wanting to improve their knowledge in this constantly developing area of medical practice Written by critical care doctors with experience of UK and European examination formats, this book leads the reader through 450 true/false questions with referenced explanations, covering core syllabus topics and key influential papers to date A detailed list of further resources and recommendations relevant to critical care revision is also provided to enable readers to further their knowledge and understanding This book will prove invaluable for preparation and success in upcoming intensive Critical Care MCQs — A Companion for Intensive Care Exams Critical Care MCQs — A Companion for Intensive Care Exams is the perfect Critical Care MCQs A Companion for Intensive Care Exams care exams for both candidates and trainers This book would be useful for not only candidates sitting the UK Fellowship of the Faculty of Intensive Care Medicine (FFICM) and European Diploma in Intensive Care (EDIC) exams, but also the Indian Diploma in Critical Care Medicine (IDCCM), the Diploma of the Irish Board of Intensive Care Medicine (DIBICM), the Australian and New Zealand Fellowship of the College of Intensive Care Medicine (CICM), the American Board and any other examinations related to intensive care ISBN 978-1-903378-99-1 781903 378991 tf m Steven Lobaz, Mika Hamilton, Alastair Glossop, Ajay Raithatha new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page i Critical Care MCQs A Companion for Intensive Care Exams Dr Steven Lobaz MBBS BMedSci FRCA FFICM Consultant in Anaesthesia and Intensive Care Medicine Barnsley Hospital NHS Foundation Trust, Barnsley, UK Dr Mika Hamilton MBChB FRCA FFICM Speciality Registrar (ST7) Anaesthesia and Intensive Care Medicine The James Cook University Hospital, Middlesbrough, UK Dr Alastair J Glossop BMedSci BMBS MRCP FRCA DICM FFICM Consultant in Anaesthesia and Intensive Care Medicine Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK Dr Ajay Raithatha MBChB MRCP FRCA FFICM EDIC Consultant in Anaesthesia and Intensive Care Medicine Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK i new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page ii Critical Care MCQs — A Companion for Intensive Care Exams tfm Publishing Limited, Castle Hill Barns, Harley, Shrewsbury, SY5 6LX, UK Tel: +44 (0)1952 510061; Fax: +44 (0)1952 510192 E-mail: info@tfmpublishing.com Web site: www.tfmpublishing.com Editing, design & typesetting: Nikki Bramhill BSc Hons Dip Law First edition: © 2015 Front cover images: © 2015 istockphoto; http://www.istockphoto.com Paperback ISBN: 978-1-903378-99-1 E-book editions: 2015 ePub ISBN: 978-1-910079-15-7 Mobi ISBN: 978-1-910079-16-4 Web pdf ISBN: 978-1-910079-17-1 The entire contents of Critical Care MCQs — A Companion for Intensive Care Exams is copyright tfm Publishing Ltd Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may not be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, digital, mechanical, photocopying, recording or otherwise, without the prior written permission of the publisher Neither the authors nor the publisher can accept responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein Neither can they accept any responsibility for errors, omissions or misrepresentations, howsoever caused Whilst every care is taken by the authors and the publisher to ensure that all information and data in this book are as accurate as possible at the time of going to press, it is recommended that readers seek independent verification of advice on drug or other product usage, surgical techniques and clinical processes prior to their use The authors and publisher gratefully acknowledge the permission granted to reproduce the copyright material where applicable in this book Every effort has been made to trace copyright holders and to obtain their permission for the use of copyright material The publisher apologizes for any errors or omissions and would be grateful if notified of any corrections that should be incorporated in future reprints or editions of this book ii Printed by Gutenberg Press Ltd., Gudja Road, Tarxien, PLA 19, Malta new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page iii l Contents Page Preface iv Acknowledgements v Introduction vi Dedication vii Paper 1: Questions Paper 1: Answers 31 Paper 2: Questions Paper 2: Answers 99 127 Paper 3: Questions Paper 3: Answers 197 225 Paper 4: Questions Paper 4: Answers 293 321 Paper 5: Questions Paper 5: Answers 385 415 Intensive Care Resources 487 Index 489 iii new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page iv l Preface To many candidates the prospect of sitting an intensive care medicine exam can be daunting The specialty is vast in its scope, one which is developing and evolving rapidly However, with hard work and dedication, success can be achieved by the majority of candidates We believe that this book, written by doctors who have collectively passed the UK FFICM and European Diploma examinations, is a perfect companion and guide to success in critical care exams It encompasses both core syllabus topics and recent influential papers, and is an invaluable resource for preparation and success Good luck! Dr Steven Lobaz MBBS BMedSci FRCA FFICM Dr Mika Hamilton MBChB FRCA FFICM Dr Alastair J Glossop BMedSci BMBS MRCP FRCA DICM FFICM Dr Ajay Raithatha MBChB MRCP FRCA FFICM EDIC January 2015 iv new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page v l Acknowledgements The authors would like to thank Dr Helen Ellis for her time and efforts in testing and critiquing the papers in this book Her comments have proved invaluable during the final editorial process and we are very grateful for this We would also like to thank Nikki Bramhill at tfm publishing for helping to make this book a reality v new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page vi l Introduction Through five complete examination papers, each compromising 90 questions of true or false stems, this book takes the reader through the core areas of intensive care medicine Each paper is designed to cover a wide range of syllabus topics relevant to several major examination formats including: the UK Fellowship of the Faculty of Intensive Care Medicine (FFICM), the European Diploma in Intensive Care (EDIC), the Indian Diploma in Critical Care Medicine (IDCCM), the Diploma of the Irish Board of Intensive Care Medicine (DIBICM), the Australian and New Zealand Fellowship of the College of Intensive Care Medicine (CICM), and American board exams The questions are set at a level designed to test the knowledge of higher trainees in the specialty A score of 72-74% (with a positive marking scoring system) is deemed the pass mark for each paper, which is comparable to the pass mark for the MCQ section of the FFICM examination Following each 90-question paper, an answer overview can be found Each answer has the question title, summary of the true stems and a brief explanation and discussion attached Relevant and up-to-date references are listed at the end of each answer A detailed list of further resources and recommendations relevant to critical care is provided at the end of the book, enabling readers to further their knowledge base and level of understanding vi Success in MCQ examinations requires a strong knowledge base but also good examination technique We hope that this book will provide prospective candidates with the question practice and background reading required to be successful We wish you the best of luck new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page vii l Dedication I wish to dedicate this book to all the staff at the Royal Victoria Infirmary and Freeman Hospital, Newcastle-upon-Tyne, UK, in particular, Dr Kirk, Mr Hassan, Dr Smith and all staff involved in paediatric cardiology, surgery, anaesthesia and critical care Without their efforts and expertise I would not have been given the most precious gift — the chance to be a father to my daughter Eva Words cannot express my eternal gratitude Thank you Dr Steven Lobaz MBBS BMedSci FRCA FFICM vii new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page viii Critical Care MCQs — A Companion for Intensive Care Exams “Believe in yourself! Have faith in your abilities! Without a humble but reasonable confidence in your own powers you cannot be successful or happy.” Norman Vincent Peale viii new-Paper questions_Paper questions.qxd 24/01/15 10:57 AM Page “Fortune favours the prepared mind.” Louis Pasteur MCQ Paper 1: Questions l a b c d e l a b c d e Question 1: In relation to the drug sugammadex: It is recommended for immediate reversal of vecuronium It can effectively reverse cisatracurium 16mg/kg is recommended intravenously for the immediate reversal of rocuronium It is an α-cyclodextrin that encapsulates aminosteroid neuromuscular blocking agents Sugammadex may be effective in treating rocuronium-induced anaphylaxis Question 2: For patients with coronary artery stents undergoing non-cardiac surgery: Non-urgent surgery should be delayed in the immediate post-stent period Drug-eluting stents (DES) have reduced restenosis rates at year, when compared to bare metal stents (BMS) Bare metal stents (BMS) require 4-6 months of clopidogrel therapy Dual antiplatelet therapy is associated with an increased perioperative mortality Biocompatible stents (e.g Genous™ R-stent) require peri-operative bridging therapy new-Index_Index.qxd 23/01/15 7:46 PM Page 491 Index blast injuries 5.52 bleeding see haemorrhage blood pressure 2.13 hypertensive crisis 4.12 blood transfusions acute transfusion reactions 4.13 complications 3.2 in Jehovah’s Witnesses 4.5 red cells 1.10 storage 3.61 bone marrow transplantation 1.9, 3.32 botulism 2.51, 4.44 bowel conditions colitis 4.76 diarrhoea 4.31 obstruction 4.20 perforation 3.60 brain arterial circulation 1.8 cerebral blood flow 2.32, 2.38 EEG 2.33 encephalitis 4.32, 5.34 herniation 1.38 intracerebral haemorrhage 3.66 ischaemic stroke 3.82, 5.15 and liver failure 3.87, 4.28 oxygenation 2.30 subarachnoid haemorrhage 3.27, 5.26 trauma 3.40, 4.87 vCJD 4.22 brainstem death 1.43, 3.7, 4.80 organ donation 3.55 bronchial anatomy 1.31 bronchoscopy 1.7 burns 1.60, 2.67, 3.33 caustic agents 4.40 scalds 4.56 caffeine 2.27 calcium 2.73, 4.71 hypocalcaemia 4.16 calcium channel blockers 3.53 carbon dioxide (CO2) monitoring (capnography) 2.90, 4.70 carbon monoxide (CO) poisoning 5.32, 5.53 cardiac abnormalities, congenital 2.14 cardiac arrest neurological outcome 2.56 therapeutic hypothermia 1.89, 2.10 cardiac arrhythmias antiarrhythmic agents 3.4, 4.34 491 new-Index_Index.qxd 23/01/15 7:46 PM Page 492 Critical Care MCQs — A Companion for Intensive Care Exams atrial fibrillation 3.78, 5.15 cardiac pacing 1.17, 5.83 dominant R-waves 1.64 electrical cardioversion 1.15, 4.47, 4.54 LQTS/torsade de pointes 5.16, 5.17 cardiac failure causes of RV failure 3.63 management 1.81, 1.88, 2.8, 5.18 cardiac ischaemia see acute coronary syndrome cardiac physiology/monitoring electrical bioimpedance 2.16 heart-lung interactions 3.76 LiDCO 2.24 PACs 1.29, 3.21, 3.50, 3.58 PAOP 4.15 PiCCO 1.28 preload status 2.18, 3.81 see also echocardiography; electrocardiography cardiac transplantation 3.69, 4.58 heart-lung 5.60 cardiac valves infective endocarditis 4.9 surgery 4.11 cardiomyopathy, peripartum 3.35 cardiopulmonary bypass 5.20 cardiopulmonary exercise testing (CPET) 5.2 cardiopulmonary resuscitation (CPR) adults 1.58, 3.30 children 1.59 DNAR orders 4.39 catecholamines 3.65 caustic agent ingestion 4.40 central venous catheters (CVC) 2.5, 5.5 cerebral arterial circulation 1.8 cerebral blood flow (CBF) 2.32, 2.38 cerebral oedema 4.28 cerebrospinal fluid (CSF) 1.87, 2.4, 4.2, 5.35 cervical cord injuries 1.35, 1.63 chest drains 2.6, 3.8 chest trauma 2.60 Child-Pugh score 4.24 children see paediatrics chloride ions, hyperchloraemia 2.61 cholecystitis, acalculous 3.79 clinical governance 1.3, 1.77, 5.77 clinical trials hierarchy of evidence 2.64 RCTs 2.63, 5.66 492 Clostridium difficile 3.34, 4.45 new-Index_Index.qxd 23/01/15 7:46 PM Page 493 Index coagulation abnormalities 4.8, 5.11 anticoagulants 3.59, 5.81 DIC 2.9 procoagulants 2.59, 4.18 thromboelastography 3.14, 5.89 thromboembolism 4.48, 4.64 colitis 4.76 colloids 3.42, 3.84 Confidential Enquiry into Maternal Deaths in the UK (2006-2008) 5.55 confidentiality 4.61 congenital heart disease 2.14 connective tissue disorders 5.49 consent 4.5, 4.61 to organ donation 5.43 contrast-induced nephropathy (CIN) 3.75 coronary artery anatomy 5.4 coronary artery revascularisation 4.17 coronary artery stents 1.2 corrected flow time (FTc) 3.81 cortisol, Addisonian crisis 3.17 CPR see cardiopulmonary resuscitation cranial nerves (CN) 3.77 creatine kinase (CK), elevated 2.47 Creutzfeldt-Jakob disease, variant form (vCJD) 4.22 cricothyroid membrane 4.4 cricothyroidotomy 2.1 crush injuries 5.61 crystalloids 2.79, 3.5, 3.73 CSF (cerebrospinal fluid) 1.87, 2.4, 4.2, 5.35 death brainstem 1.43, 3.7, 4.80 cardiorespiratory 2.41 maternal mortality 5.55 defibrillation 1.15, 4.54 safety 4.47 delayed waking after anaesthesia 3.1 delirium 2.80, 4.33 dexmedetomidine 3.26 diabetes diabetic ketoacidosis 5.73 hyperosmolar hyperglycaemic state 5.74 diaphragmatic foramina 3.47 diarrhoea 4.31 digoxin toxicity 1.84 disseminated intravascular coagulation (DIC) 2.9 not attempt resuscitation (DNAR) orders 4.39 Doppler ultrasound transcranial 2.38 493 new-Index_Index.qxd 23/01/15 7:46 PM Page 494 Critical Care MCQs — A Companion for Intensive Care Exams transoesophageal 1.27, 3.52, 3.81, 5.44 drowning 1.53, 4.90 drugs (pharmaceuticals) adverse effects see adverse effects pharmacokinetics 4.37, 5.40 used in critical care 5.41 see also specific drugs/drug classes drugs of abuse 1.33, 2.34 echocardiography 1.44, 2.42, 4.86 transoesophageal 1.27, 3.52, 3.81, 5.44 eclampsia 1.55 ECMO (extracorporeal membrane oxygenation) 3.37, 3.72, 4.63 electrical bioimpedance cardiac output monitoring 2.16 electrical cardioversion 1.15, 4.54 safety 4.47 electrocardiography (ECG) 1.13, 4.14 dominant R-waves 1.64 electrolyte disorders 5.57 normal 2.89 electrocution 3.89 electroencephalography (EEG) 2.33 electrolytes anion gap 1.73, 4.60 electrocardiography 5.57 see also individual electrolytes embolism amniotic fluid 2.54 pulmonary 4.64 empyema 3.43 encephalitis 4.32, 5.34 encephalopathy, hepatic 3.87 end-tidal CO2 monitoring 4.70 endocarditis 4.9 endocrinology 3.17, 4.52 see also thyroid hormones endoscopy 2.15 enteral nutrition 2.25 epidural catheters 1.36, 3.13 epilepsy 2.44, 4.30 etanercept 2.49 ethics consent 4.5, 4.61 withdrawal of treatment 5.65 ethylene glycol poisoning 1.23 exercise testing 5.2 extracorporeal membrane oxygenation (ECMO) 3.37, 3.72, 4.63 extubation 5.71 494 exudates 4.67 new-Index_Index.qxd 23/01/15 7:46 PM Page 495 Index Factor VIIa 2.59 FAST scan (focused assessment with sonography in trauma) 3.70, 5.10 FiO2 (inspired oxygen delivery) 1.68 fluid management 2.28, 5.58 see also intravenous fluids fungal infections antifungal agents 5.48 disseminated 5.47 gallbladder, cholecystitis 3.79 gastrointestinal (GI) tract bleeding 1.19, 1.20, 2.15 colitis 4.76 diarrhoea 4.31 endoscopy 2.15 ischaemia 5.22 obstruction 4.20 perforation 3.60 gastroparesis 4.23 general anaesthesia complications 4.1, 4.72 delayed waking 3.1 intravenous agents 4.84, 5.1, 5.38, 5.39 monitoring 2.2 Glasgow Coma Scale (GCS) 1.34 glucocorticoids Addisonian crisis 3.17 adverse effects 1.50 prednisolone 4.78 graft versus host disease 1.9, 3.32 haematological malignancies 3.32, 4.81, 5.9 haemodialysis/haemofiltration see renal replacement therapy haemoglobin 1.57 haemoglobinopathies and coagulation disorders 5.11 sickle cell 4.7 haemorrhage gastrointestinal 1.19, 1.20, 2.15 intracerebral 3.66 obstetric 2.57, 5.56 procoagulant treatment 2.59, 4.18 subarachnoid 3.27, 5.26 haemorrhagic fever 2.48 Hartmann’s solution 2.79 heart see entries at cardiac heat 3.9 HELLP syndrome 1.55 heparin-induced thrombocytopenia (HIT) 1.6, 1.11, 5.8 hepatic disease see liver disease 495 new-Index_Index.qxd 23/01/15 7:46 PM Page 496 Critical Care MCQs — A Companion for Intensive Care Exams hepatic encephalopathy 3.87 hepatitis A 5.27 hepatitis B 2.21 hepatitis C 2.23 hepatitis E 1.90 hepatorenal syndrome (HRS) 4.10 high-frequency ventilation (HFV) 2.71, 3.71 HIV see human immunodeficiency virus human albumin solution (HAS) 3.42 human immunodeficiency virus (HIV) 1.48, 4.79, 5.51 anti-retroviral therapy 1.49, 2.45 humidification 3.6 hyperbaric oxygen therapy 1.70 hyperbilirubinaemia 3.51 hypercalcaemia 4.71 hyperchloraemic acidosis 2.61 hyperkalaemia 4.68, 5.57 hyperlactaemia 4.26 hypernatraemia 5.82 hyperosmolar hyperglycaemic state (HHS) 5.74 hyperpyrexia, malignant 4.1 hypertension hypertensive crisis 4.12 pre-eclampsia 1.54, 5.21 hyperthermia 4.29 hyperthyroidism 2.77 hypertonic saline 3.5 hypocalcaemia 4.16 hypokalaemia 4.68 hyponatraemia 5.63, 5.76 hypothermia, therapeutic 1.89, 2.10, 2.11, 5.75 hypothyroidism 2.69 hypoxia 5.6 idiopathic thrombocytopenic purpura (ITP) 5.11 industrial chemical poisoning 1.23, 4.25 infection control 2.20, 4.74, 5.77 infective endocarditis (IE) 4.9 infliximab 2.49 influenza A 2.46 H1N1 pandemic 2.50 Injury Severity Score (ISS) 5.62 inotropes 4.85 intestinal conditions see bowel conditions intra-abdominal hypertension 2.26 intra-abdominal sepsis 4.21 intra-aortic balloon pumps (IABP) 1.16, 5.50 intracerebral haemorrhage (ICH) 3.66 496 intracranial perfusion 2.32, 2.38 new-Index_Index.qxd 23/01/15 7:46 PM Page 497 Index intracranial pressure (ICP) monitoring 2.31, 5.85 raised 1.38, 1.41 waveforms 1.39 intravenous fluids 1.41, 2.79, 3.5, 3.42, 3.73, 3.84 intubation ‘can’t intubate, can’t ventilate’ 1.4 paediatric 5.46 in pregnancy 4.49 in TBI 4.87 ischaemic stroke 3.82, 5.15 isotonic saline 3.73 jaundice 3.51 Jehovah’s Witnesses 4.5 kidney disease see renal disease kidney structure and function 4.77, 5.72 lactate 2.88, 4.26 laryngectomy 2.3 larynx 1.12 left ventricular assist devices (LVADs) 1.88, 2.8 lithium dilution cardiac output (LiDCO) monitoring 2.24 liver disease acute liver failure cerebral oedema risk 4.28 classification 1.22 management 1.18 and transplantation 1.30, 2.87 alcoholic 1.25 chronic ascites 5.19 Child-Pugh score 4.24 decompensated 5.33 SBP 1.24 drug-induced 4.36 hepatic encephalopathy 3.87 hepatitis A 5.27 hepatitis B 2.21 hepatitis C 2.23 hepatitis E 1.90 hepatorenal syndrome 4.10 jaundice 3.51 liver function tests 3.64 postoperative management of resection 3.85 scoring systems 3.25, 4.24 TIPS 2.22 uncommon diagnoses 2.19 497 new-Index_Index.qxd 23/01/15 7:46 PM Page 498 Critical Care MCQs — A Companion for Intensive Care Exams liver transplantation 2.55 in ALF 1.30, 2.87, 5.25 criteria for 1.61, 2.87, 5.25 in end-stage liver disease 2.76 postoperative period 3.38, 4.55, 5.59 local anaesthesia 5.12 long QT syndrome (LQTS) 5.16, 5.17 lumbar drains 1.36 lumbar puncture 5.34 lung anatomy 1.31 asthma 5.68 heart-lung interactions 3.76 heart-lung transplantation 5.60 pneumonia (VAP) 1.67, 3.12, 5.69 ventilator-induced lung injury 3.86, 5.78 see also respiratory failure lung function tests 4.69 macrocytosis 3.41 macrophage activation syndrome (MAS) 3.48 magnesium 2.84, 4.73, 5.21 magnetic resonance imaging (MRI) 5.84 malaria 4.42 malignant hyperpyrexia (MH) 4.1 mannitol 1.41 mean corpuscular volume (MCV), raised 3.41 meningitis 1.46, 3.28 meningoencephalitis 5.34 microdialysis, brain 2.30 motor nerves 1.37 multi-drug resistance 4.46 muscles crush injuries 5.61 rhabdomyolysis 2.68 weakness 2.35 myocardial infarction coronary artery revascularisation 4.17 non-STEMI 5.14 STEMI 3.22 troponins 4.19, 5.13 myxoedema coma 2.69 N-acetylcysteine (NAC) 1.32 nasogastric/nasojejunal feeding tubes 2.25 natriuretic peptides 5.24 neck injuries 1.35, 1.63 necrotising fasciitis 5.31 498 neonates circulation 3.20 new-Index_Index.qxd 23/01/15 7:46 PM Page 499 Index intensive care 3.56 resuscitation 4.53 nephritis, tubulo-interstitial 3.44 nephropathy, contrast-induced 3.75 nerve conduction 1.37 neurogenic shock 4.57 neutropenic sepsis 2.7 non-invasive ventilation (NIV) 2.86, 5.88 contraindications 3.15 non-parametric data 4.62 noradrenaline (norepinephrine) 3.65 nosocomial infections 4.74, 5.77 VAP 1.67, 3.12, 5.69 nutrition 2.75 enteral 2.25 requirements 2.81, 2.83 obesity surgery 3.23 oesophageal Doppler 1.27, 3.52, 3.81, 5.44 oesophagus surgery 1.21 variceal bleeding 1.19, 1.20 opioids 2.40 oral decontamination 2.20 organ donation after brainstem death (DBD) 3.55 after circulatory (cardiac) death (DCD) 2.65, 4.38 consent 5.43 management of the heart-beating donor 5.42 osmolar gap 1.73 outreach services 1.77 overdose amitriptyline 2.36 baclofen 4.27 calcium channel blockers 3.53 digoxin 1.84 drugs of abuse 1.33 paracetamol 1.32 quinine sulphate 1.5 renal replacement therapy 3.80, 4.75 salicylate 3.67 signs and symptoms 3.54 treatments 3.39 oxygen delivery (DO2) 1.26, 3.24 hyperbaric 1.70 hypoxia 5.6 inspired oxygen delivery (FiO2) 1.68 pulse oximetry 2.85, 4.51, 5.67 toxicity 1.69 499 new-Index_Index.qxd 23/01/15 7:46 PM Page 500 Critical Care MCQs — A Companion for Intensive Care Exams venous saturation (SvO2) 5.29 pacemakers 1.17, 5.83 paediatrics 3.56 airway emergencies 1.47 congenital causes of difficult airways 5.45 intubation 5.46 meningococcal disease 1.46 neonatal circulation 3.20 resuscitation 1.59, 4.53 status epilepticus 2.44 trauma 4.41 pain 3.29 pain management 1.42, 2.40 pancreatitis acute 2.17, 3.49 necrotising 3.3 paracentesis 5.19 paracetamol (acetaminophen) overdose 1.32 patient position 1.85, 2.78 patient transfer 1.45, 2.43 pelvic trauma 1.62, 5.64 peripartum cardiomyopathy (PPCM) 3.35 peritonitis 1.24, 4.21 phaeochromocytoma 3.16 pharmacokinetics 4.37, 5.40 phosphodiesterase inhibitors 2.37 physiotherapy 4.66 PiCCO cardiac monitor 1.28 Plasmodium falciparum malaria 4.42 plethysmography 2.16 pleural effusion aspiration 2.6 exudative 4.67 pneumonia, ventilator-associated 1.67, 3.12, 5.69 pneumothorax 3.88 poisoning drug toxicity see overdose ethylene glycol 1.23 industrial chemicals 4.25 inhalational 5.32, 5.53 oxygen toxicity 1.69 sarin 2.51 porphyric crisis 5.7 positive end-expiratory pressure (PEEP) 2.74 postpartum haemorrhage (PPH) 2.57, 5.56 potassium 2.72, 3.74 hypo/hyperkalaemia 4.68, 5.57 500 prednisolone 4.78 pre-eclampsia 1.54, 5.21 new-Index_Index.qxd 23/01/15 7:46 PM Page 501 Index pregnancy 4.83 amniotic fluid embolism 2.54 drugs 3.10 eclampsia and HELLP syndrome 1.55 haemorrhage 2.57, 5.56 intubation 4.49 maternal mortality 5.55 peripartum cardiomyopathy 3.35 physiology 3.68, 4.83, 5.54 pre-eclampsia 1.54, 5.21 resuscitation 2.52 sepsis 4.50 venous thromboembolism 4.48 preload 2.18, 3.81 pressure, and temperature 2.53 prion disease 4.22 prone position 1.85, 2.78 propofol 4.84, 5.39 propofol infusion syndrome (PRIS) 4.72 prothrombin complex concentrate (Beriplex®) 4.18 pulmonary artery catheters (PAC) 1.29, 3.21, 3.50 insertion 3.58 pulmonary artery occlusion pressure (PAOP) 4.15 pulmonary embolism (PE) 4.64 pulmonary function tests 4.69 pulse oximetry 2.85, 4.51, 5.67 quinine sulphate overdose 1.5 radiation exposure 2.29, 3.89 randomised controlled trials (RCTs) 2.63, 5.66 recreational drugs 1.33, 2.34 red cell transfusions see blood transfusions refusal of treatment 4.5, 4.61 renal disease acute renal failure 1.74, 1.78, 1.82, 2.68 contrast-induced nephropathy 3.75 hepatorenal syndrome 4.10 tubulo-interstitial nephritis 3.44 renal replacement therapy (RRT) 4.6 continuous 5.80, 5.81 for overdose 3.80, 4.75 vascular access 5.79 renal structure and function 4.77, 5.72 respiratory failure ARDS 1.66, 5.70 in rheumatoid arthritis 1.51 resuscitation adult CPR 1.58, 3.30 burns patients 1.60 501 new-Index_Index.qxd 23/01/15 7:46 PM Page 502 Critical Care MCQs — A Companion for Intensive Care Exams DNAR orders 4.39 fluid management 5.58 neonates 4.53 paediatric CPR 1.59 in pregnancy 2.52 rhabdomyolysis 2.68, 5.61 rheumatoid arthritis, respiratory failure 1.51 RIFLE classification 1.74 right ventricle (RV) failure 3.63 rotational thromboelastometry (ROTEM®) 5.89 salicylate overdose 3.67 saline hypertonic 3.5 isotonic 3.73 sarin 2.51 scalds 4.56 sedation 4.35 in delirium 2.80 seizures 2.44, 4.30 selective oral/digestive decontamination 2.20 Sengstaken-Blakemore tubes 1.20 sepsis diagnosis 4.89 intra-abdominal 4.21 management 1.83 neutropenic 2.7 pathophysiology 3.31 in pregnancy 4.50 septic shock 5.36 shock 4.57, 5.28, 5.36 SI units 1.56 sickle cell disease 4.7 side effects see adverse effects sodium 1.76, 3.45 hypernatraemia 5.82 hyponatraemia 5.76 raised urinary levels with plasma hyponatraemia 5.63 sodium chloride solutions see saline spinal cord anatomy 3.62 spinal cord injury (SCI) cervical 1.35, 1.63 spinal shock 4.57 in unconscious patients 3.57 spinal cord syndromes 3.83 splanchnic ischaemia 5.22 spontaneous bacterial peritonitis (SBP) 1.24 starch-based intravenous fluids 3.84 502 statistics 1.65, 3.36, 4.62 status epilepticus (SE) 2.44, 4.30 new-Index_Index.qxd 23/01/15 7:46 PM Page 503 Index stents 1.2 steroids see glucocorticoids stroke haemorrhagic 3.27, 3.66, 5.26 ischaemic 3.82, 5.15 subarachnoid haemorrhage (SAH) 3.27, 5.26 sugammadex 1.1 suxamethonium apnoea 3.46 Swan-Ganz catheters see pulmonary artery catheters sympathomimetic drugs 2.39 temperature heat 3.9 hyperthermia 4.29 and pressure 2.53 regulation 1.52 therapeutic hypothermia 1.89, 2.10, 2.11, 5.75 tetanus 4.44 therapeutic hypothermia 2.11, 5.75 after cardiac arrest 1.89, 2.10 thiopental 5.1 thoracic inlet 4.3 thrombocytopaenia, heparin-induced (HIT) 1.6, 1.11, 5.8 thromboelastography (TEG) 3.14, 5.89 thromboembolism PE 4.64 in pregnancy 4.48 thrombotic thrombocytopenic purpura (TTP) 5.11 thyroid hormones myxoedema coma 2.69 physiology 1.79 thyroid function tests 5.87 thyroid storm 2.77 TNF-α antagonists 2.49 torsade de pointes 5.17 tracheostomy 2.3, 3.90, 4.65 tranexamic acid 2.59 transcranial Doppler sonography (TCD) 2.38 transfer of patients 1.45, 2.43 transfusions see blood transfusions transjugular intrahepatic portosystemic shunt (TIPS) 2.22 transoesophageal echo (TOE) 1.27, 3.52, 3.81, 5.44 transplantation bone marrow 1.9, 3.32 heart 3.69, 4.58 heart-lung 5.60 liver see liver transplantation organ donation 2.65, 3.55, 4.38, 5.42, 5.43 transpulmonary pressure (TPP) 5.78 transurethral resection of prostate (TURP) syndrome 5.3 503 new-Index_Index.qxd 23/01/15 7:46 PM Page 504 Critical Care MCQs — A Companion for Intensive Care Exams trauma 2.58, 4.59 paediatric 4.41 see also specific injuries traumatic brain injury (TBI) 3.40, 4.87 tropical diseases 2.48, 4.42 troponins 4.19, 5.13 tuberculosis (TB) 4.43 tumour lysis syndrome 2.12 Type II errors 3.36 ultrasound 4.86 FAST scan 3.70, 5.10 transcranial Doppler 2.38 see also echocardiography valvular heart disease 4.9, 4.11 variceal bleeding 1.19, 1.20 vasculitides 1.80 vasopressors 2.39, 3.65, 4.85 Vaughan-Williams classification 4.34 venous oxygen saturation (SvO2) 5.29 venous thromboembolism 4.48 ventilation 1.4, 1.86, 2.66 complications of ventilatory support 1.67, 1.71, 3.12, 3.86, 5.69, 5.78 controlled 2.62 high-frequency 2.71, 3.71 non-invasive 2.86, 3.15, 5.88 oxygen delivery 1.26, 1.68, 3.24 PEEP 2.74 prone position 2.78 weaning 2.70 see also extubation; intubation ventilator-associated pneumonia (VAP) 1.67, 3.12, 5.69 ventricular assist devices (VADs) 1.88, 2.8 viral haemorrhagic fever 2.48 viral hepatitis see entries at hepatitis vitamins 2.83 weakness 2.35 Well’s criteria 4.64 withdrawal signs/symptoms 5.30 withdrawal of treatment 5.65 504 Critical Care MCQs — A Companion for Intensive Care Exams is the perfect companion for anyone sitting exams in intensive care, as a training resource or just wanting to improve their knowledge in this constantly developing area of medical practice Written by critical care doctors with experience of UK and European examination formats, this book leads the reader through 450 true/false questions with referenced explanations, covering core syllabus topics and key influential papers to date A detailed list of further resources and recommendations relevant to critical care revision is also provided to enable readers to further their knowledge and understanding This book will prove invaluable for preparation and success in upcoming intensive care exams for both candidates and trainers This book would be useful for not only candidates sitting the UK Fellowship of the Faculty of Intensive Care Medicine (FFICM) and European Diploma in Intensive Care (EDIC) exams, but also the Indian Diploma in Critical Care Medicine (IDCCM), the Diploma of the Irish Board of Intensive Care Medicine (DIBICM), the Australian and New Zealand Fellowship of the College of Intensive Care Medicine (CICM), the American Board and any other examinations related to intensive care ISBN 978-1-903378-99-1 781903 378991 ...new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page i Critical Care MCQs A Companion for Intensive Care Exams Dr Steven Lobaz MBBS BMedSci FRCA FFICM Consultant in Anaesthesia... new-Prelims Critical Care MCQs_Prelims Critical Care MCQs.qxd 23/01/15 7:44 PM Page viii Critical Care MCQs — A Companion for Intensive Care Exams “Believe in yourself! Have faith in your abilities!... 10:57 AM Page Critical Care MCQs — A Companion for Intensive Care Exams l a b c d e l a b c d e l a b c d e l a b c d Question 16: Considering intra-aortic balloon pump (IABP) use: Myocardial oxygen